Expert: Dr. Sharon A. Mitchell - 12/24/2009

Question
Hello,

I'm concerned my son is on the autism spectrum.  First of all, I have a 4 1/2 year old that's been diagnosed with autism and now I'm worried about my 22 month old son.  

My 22 month old son Broderick was diagnosed with hypotonia when he was 8 months old along with tremors.  He would always shake his head back and forth really fast and stare up at the ceiling to make himself dizzy.  Broderick never looked at me when I fed him his bottle.  He also never cried for me.  He never wanted to be held or rocked.  He didn't seem to make a connection with me until he was 18 months old.  When he was 12 months he was pointing and responding to his name and making some sounds.  Everything seemed to be on track.  Then around 14 months he stopped doing quite a few things like responding to his name, babbling and waving bye bye.  At around 16 months he starting doing things again.  

Broderick is now 22 months old and is in early intervention for speech, fine motor and gross motor delays.  He has a lot of motor planning issues.  He spins and still stares up at the ceiling.  He flaps mostly.  He flaps and jumps up and down a lot every day.  He's very aggressive and hits himself and others when he gets mad.  Sometimes he has really bad tantrums and I can't seem to console him.  However.....he is pointing to things he wants, he makes eye contact, he waves bye bye and smiles at me.  He still seems quite aloof at times and in his own world.  He still doesn't like to sit on my lap or be touched.  But he will hug me now on his terms.     

Sorry to go on and on, but I wanted you to get an good idea about what Broderick is like.  

The Neurologist thinks he has early signs of autism.  The psychologist says he doesn't meet the criteria but can't say he doesn't have it.  The psychologist sees how Broderick is aloof and wants to see if there will be pragmatic problems in the future.  Broderick was interacting also.  

I'm so back and forth with this.  My gut tells me he has autism.  But how could he if he's waving and pointing?  After reading this...what impression do you get?

Thank you so much for your time.
Danielle


Answer
I can see why you go back and forth on this. It is confusing. I can also see why your neurologist suspects autistic signs, yet the psychologist  feels Broderick is not meeting all the criteria. You have outlined some of the reasons why your little guy does not have all the typical signs of autism, such as pointing. After reading what you've written, I would be sitting on the fence as well.

But does it really matter? I mean that kindly. The reason why you hear that early diagnosis of autism is so important is so that the child can receive early intervention help. Broderick is already getting help and you have obviously been pro-active in doing all that you can for your son. At his age, the important therapies would be that of occupational therapy and speech therapy. You have already taken care of that.

At its heart, autism is a communication and socialization disorder. Your son is interacting with you, smiles, makes some eye contact, etc. These are positive points. Communication is a concern; you don't mention his language skills but I presume they are delayed or you would not have the services of a speech/language interventionist. Until your son is talking more and we get a better look at his pragmatics (social language usage) it would be hard to make an autism diagnosis. Here is some information on pragmatics http://www.asha.org/public/speech/development/pragmatics.htm

Between the first and second year of life, these are some of the speech and language skills typically developed, according to the American Speech Language Hearing Association:

Hearing and Understanding

   * Points to a few body parts when asked.
   * Follows simple commands and understands simple questions ("Roll the ball," "Kiss the  baby," "Where's your shoe?").
   * Listens to simple stories, songs, and rhymes.
   * Points to pictures in a book when named.

Talking   

   * Says more words every month.
   * Uses some one- or two- word questions ("Where kitty?" "Go bye-bye?" "What's that?").
   * Puts two words together ("more cookie," "no juice," "mommy book").
   * Uses many different consonant sounds at the beginning of words.

At their website there are also suggestions of things parents can do to help their child's language skills develop http://www.asha.org/public/speech/development/12.htm

First Signs is an organization devoted to helping people recognize the early signs of autism (http://www.firstsigns.org/concerns/index.htm).  Here are some milestones to consider when wondering about autism http://www.firstsigns.org/healthydev/milestones.htm The First Signs website has an excellent video glossary depicting typically developing children and those with autism. You must register to access the videos but registration is free and carries no obligation: http://www.firstsigns.org/asd_video_glossary/asdvg_about.htm

Broderick is lucky to have you for a mum. You are on top of things already while some parents might still be trying to ignore those niggardly feelings that something might be different. You have been proactive in securing services for your child and talking with experts.

Best wishes to you and your family,

Sharon A. Mitchell, B.A, B.Ed., M.A., PhD Candidate
www.autismsite.ca